| Purpose: |
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The purpose of this study is to evaluate a group of African Americans and Caucasians with
hepatitis C virus (HCV), compare their response rates to combination treatment with
pegylated interferon alfa-2b and ribavirin, and identify possible causes for racial
differences in response to therapy. The study will enroll a total of 260 participants, age
18 or older, over a 10 period. In the next 5 years 132 subjects will be studied locally,
including 112 African Americans and 20 Caucasians. Participants will be recruited from the
clinical practices of the hepatologists (liver doctors) at the University of Tennessee
Health Science Center and will also be selected from referrals at local hepatology clinics
and the Memphis VA Hospital. Volunteers will be treated with pegylated interferon alfa-2b
injections once weekly and oral ribavirin 2 times a day for up to 72 weeks. Study procedures
include multiple blood draws. Participants may be involved in study related procedures for
up to 72 weeks.
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| Criteria: |
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Inclusion Criteria:
- Adult, male or female, African-American or Caucasian, age 18 or older.
- Serum positive for hepatitis C virus by Polymerase Chain Reaction (PCR) or other
assays [e.g. Deoxyribonucleic acid, (BDNA)].
- Liver biopsy prior to entry to this protocol with a pathology report confirming that
the histological diagnosis is consistent with chronic hepatitis.
- Compensated liver disease with the following laboratory parameters at the Entry
visit:
- Hemoglobin values of greater than or equal to 12 mg/dL
- Neutrophil count greater than or equal to 1,200/mm^3
- Platelets greater than or equal to 60,000/mm
- Albumin > 3.0 g/dL or within 20 percent of lower limit of normal (LLN)
- Serum creatinine less than or equal to 1.5 mg/dL
- Thyroid stimulating hormone (TSH) within normal limits or thyroid disease under
control
- Reconfirmation and documentation that sexually active female patients of childbearing
potential are practicing adequate contraception (intrauterine device, oral
contraceptives, progesterone implanted rods (Norplant), medroxyprogesterone acetate
(Depo-Provera), surgical sterilization, barrier method (diaphragm + spermicide), or
monogamous relationship with a male partner who has had a vasectomy or is using a
condom + spermicide) during the treatment period and for 6 months after
discontinuation of therapy. A urine pregnancy test obtained at entry prior to the
initiation of treatment must be negative. Female patients must not be
breast-feeding. Documentation that sexually active male patients are practicing
acceptable methods of contraception (vasectomy, use of a condom + spermicide,
monogamous relationship with a female partner who practices an acceptable method of
contraception) during the treatment period and for 6 months after discontinuation of
therapy.
- Written informed consent specific for this protocol has been obtained prior to entry.
Exclusion Criteria:
- Hypersensitivity to interferon or ribavirin.
- Any cause for chronic liver disease other than chronic hepatitis C.
- Active hemolytic anemia.
- Evidence of advanced liver disease such as a history of or presence of ascites,
bleeding varices, or spontaneous encephalopathy.
- Any known preexisting medical condition that could interfere with the patient's
participation in the protocol including: (Central Nervous System) CNS trauma or
uncontrolled seizure disorders; poorly controlled diabetes mellitus; serious
pulmonary disease; immunologically-mediated diseases; gout' or any medical condition
requiring, or likely to require during the course of the study, chronic
administration of steroids.
- Patients with evidence of ischemia or stress testing, Electrocardiogram (ECG)
evidence of ischemia, a significant arrhythmia, cardiac failure, recent coronary
surgery, uncontrolled hypertension, angina or a myocardial infarction within 12
months. Pretreatment stress test will be required for all participants greater than
50 years of age or 45 years of age if diabetic.
- Patients with clinically significant retinal abnormalities.
- Substance abuse, such as alcohol (greater than 80 gm/day), intravenous (IV) drugs and
inhaled drugs. If the patient has a history of substance abuse, to be considered for
inclusion into the protocol, the patient must have abstained from using the abused
substance for at least 3 months.
- Patients with a history of organ transplantation will be excluded.
- Patients infected with human immunodeficiency virus.
- Preexisting psychiatric conditions; especially severe depression, or a history of
severe psychiatric disorder, such as major psychoses, active suicidal ideation and/or
suicidal attempt are excluded. Patients with a history of mild depression may enter
the protocol if they meet the following eligibility criterion and are monitored more
intensively. Mild depression includes either situational depression for a limited
period or depressive symptoms, which do not significantly interfere with the
patient's work or daily functions. All patients will complete the Center for
Epidemiological Studies Depression Scale (CES-D). The CES-D is a 20-item self-report
scale designed to measure depressive symptomatology experienced during the week prior
to the interview. The items are scored on a four-point scale (0-3), with the total
score ranging from zero to 60. CES-D scores of 16-20 suggest minor depression, and
scores greater than 20 suggest major depression. The score can be determined in real
time. A score of 16 or higher should prompt further questioning and consideration of
treatment or referral to psychiatry. Detailed follow-up of each patient may be
individualized according to his/her need; this would usually include predetermined
visits.
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